PARENTAL AND PRIMARY-CARE PHYSICIANS VIEWS ON THE MANAGEMENT OF CHRONIC DISEASES - A STUDY IN ITALY

A survey on the burden and quality of care and the parental and primar y care physicians' views on management of eight chronic illnesses and disabilities was conducted from 1990 to 1993. Data were collected on 9 93 children and adolescents from family interviews and physicians' pos tal questionnaires. Approximately 70% of patients used two or more ser vices for care management and 149 children were treated outside their region. Only 36% of the physicians were case managers and half of thes e agreed that better communication with other care providers could fac ilitate their role. A wide difference in parental satisfaction was fou nd between medical and disabling conditions. Approximately 90% of the parents expressed satisfaction with care for children with coeliac dis ease (112/120), asthma (80/89) and diabetes (98/111), whereas approxim ately one-third of parents of children with cerebral palsy and Down's syndrome were dissatisfied (88/242 and 72/189, respectively). Primary care physicians expressed similar satisfaction with case management. D istance from hospital, the need for more information on disease manage ment and financial aid were the sources of greatest dissatisfaction. C hildren with disabling diseases had more problems integrating at schoo l than children with other chronic disorders. Closer interaction betwe en health services, providers and families is necessary to manage the needs of disabled (Italian) children better.